Psychosocial differences between criminal-justice-referred and voluntary clients, using a sample ... more Psychosocial differences between criminal-justice-referred and voluntary clients, using a sample of 996 men and women in residential drug treatment in northern New Jersey, were explored. Results suggest differences in demographic characteristics between the two groups as well as differences in attitudes and behaviors likely to impact on treatment outcome. Demographically, criminal-justice clients are younger, more likely to be male, and less likely to be Black than other clients. They also report better health status and better social and psychological adjustment. reporting less homelessness, fewer health problems, lower levels of psychological distress, better family adjustment. and fewer medical, social, and drug problems requiring intervention. Implications for treatment are discussed.
Catastrophic appraisal has been implicated as a possible cause of psychiatric morbidity, psycholo... more Catastrophic appraisal has been implicated as a possible cause of psychiatric morbidity, psychological distress, and physical impairment in individuals with chronic pain. At issue in this study was whether catastrophizing was associated with psychiatric morbidity in a population sample of National Guard members. In addition, we sought to determine whether it could account for individual differences in psychological distress and impaired physical function in the presence of acute and chronic pain. We performed a secondary analysis of an existing survey database. The original survey was designed to assess combat readiness in a population sample of 2995 National Guard troops about to deploy overseas. The database included screening instruments for psychiatric illness as well as continuous measures of psychological distress, pain perception, pain catastrophizing, and perceived physical function. Among Guard members reporting a problem with pain, frequent catastrophizing was associated with higher rates of depression, posttraumatic stress, alcohol dependence, and somatization-like illness. Higher rates were also associated with chronic as opposed to acute pain (except for alcohol dependence). Pain-related catastrophizing accounted for substantial variance in measures of psychological distress and physical impairment regardless of pain duration. Although catastrophizing beliefs are common in clinical settings, this study suggests that the phenomenon may be prevalent in the population at large and likely to influence the outcome of acute as well as chronic pain.
A recent cross-sectional study of National Guard troops found that pain and pain catastrophizing ... more A recent cross-sectional study of National Guard troops found that pain and pain catastrophizing were prevalent and highly correlated with posttraumatic stress disorder (PTSD). At issue in the present study was whether pain and catastrophizing before military deployment could account for individual differences in PTSD symptoms after deployment. An anonymous survey was administered to a population sample of New Jersey National Guard troops before they were sent overseas and again when they returned home (1 year later). The survey included a validated PTSD screening questionnaire, numerical ratings of pain intensity, and a measure of pain catastrophizing. A cohort of 922 National Guard members completed the survey before and after deployment. An uncontrolled analysis indicated that pain and catastrophizing before deployment were significantly but modestly associated with PTSD symptoms after deployment (accounting for 4.5% and 1.3% of the variance, respectively). A hierarchical regression model that controlled for sex, preexisting PTSD symptoms, and recent combat found that pain but not pain catastrophizing explained variance in postdeployment PTSD. The size of the effect, however, was negligible (0.8%, p<.01). Consistent with previous research, a cross-sectional analysis revealed that postdeployment pain and catastrophizing successfully accounted for unique variance in postdeployment PTSD. The failure of longitudinal predictors in the present study, therefore, cannot be attributed to insensitive screening instruments. These findings offer little or no support for the hypothesis that predeployment pain and catastrophizing can account for individual differences in PTSD after exposure to combat trauma.
Background: Chronic pain is highly prevalent among people in methadone maintenance treatment (MMT... more Background: Chronic pain is highly prevalent among people in methadone maintenance treatment (MMT) for opioid use disorder and is known to be an important contributor to treatment discontinuation and opioid relapse. Mindfulness-Oriented Recovery Enhancement (MORE) is one of the few interventions developed and tested as an integrated treatment to simultaneously address both pain and illicit opioid use; however, this study is the first to evaluate MORE as an adjunct to MMT. Methods: Randomized individuals in MMT (N = 30) received MORE plus methadone TAU (n = 15) or methadone TAU, only (n = 15). Participants in the MORE arm received their MMT, as usual, and attended eight, weekly, two-hour MORE groups at their MMT clinics. Participants in the TAU arm received their MMT, as usual, and group or individual counseling, as required by the clinic. TAU counseling consisted of relapse prevention, cognitive-behavioral therapy, and supportive treatment. TAU participants did not receive any mindfulness-based intervention. Participants completed assessments at baseline, post-treatment (i.e., 8-weeks post-baseline), and follow-up (i.e., 16-weeks post-baseline). Results: Participants in MORE evidenced significantly fewer baseline adjusted days of illicit drug use and significantly lower levels of craving through 16-week follow-up compared to TAU. Also, Participants in MORE reported significantly lower levels of pain, physical and emotional limitations, depression, and anxiety through 16-week follow-up compared to TAU. Conversely, participants in MORE reported significantly higher levels of well-being, vitality, and social functioning through 16-week follow-up compared to TAU. Conclusion: MORE could be an effective adjunct to MMT, and larger trials are warranted.
Abstract Background: To address the alarming rise in opioid overdose deaths, states have increase... more Abstract Background: To address the alarming rise in opioid overdose deaths, states have increased public access to the overdose reversal medication, naloxone. While some studies suggest that increased naloxone accessibility reduces opioid overdose deaths, others raise concerns about unintended consequences, such as increases in risky drug use and opioid re-use post-overdose to counter naloxone-induced withdrawal symptoms. Few studies have examined the impact of expanded naloxone access on the attitudes and behaviors of opioid users. Methods: In this qualitative study, we conducted in-depth, semi-structured interviews with 36 English-speaking opioid users 18+ years of age. Informants were recruited from an urban methadone clinic, a needle exchange program and a residential treatment program. The approximately hour-long interviews focused on users’ attitudes and behaviors surrounding naloxone, opioid use and overdose. Transcribed audio-recordings of interviews were analyzed using NVivo. Results: Informants were ambivalent about naloxone, widely acknowledging its life-saving benefits while reporting such negative effects as severe withdrawal symptoms and the promotion of riskier drug use. Naloxone-induced withdrawal, coupled with misperceptions about naloxone’s pharmacological effects, prompted overdose survivors to rapidly re-use opioids and refuse hospitalization following an overdose reversal. About half the sample believed naloxone led to greater risk-taking by others, such as fentanyl use or use in higher quantities, but did not endorse riskier drug use themselves. Conclusions: The results suggest the need for targeted education about the pharmacological effects of naloxone and better strategies for managing naloxone-induced withdrawal. Future research should focus on the extent to which naloxone is associated with greater opioid risk-taking.
BACKGROUND Attempts to reduce opioid overdoses have been complicated by the dramatic rise in fent... more BACKGROUND Attempts to reduce opioid overdoses have been complicated by the dramatic rise in fentanyl use. While market forces contributing to fentanyl proliferation in the illicit drug supply have increased inadvertent exposure to the drug, rising fentanyl use may also be driven by growing consumer demand. Interventions to reduce the spread of fentanyl must be based on an understanding of the motivations underlying its use. METHODS Data for this cross-sectional study were derived from a computerized self-administered survey completed by a convenience sample of 432 people who use illicit opioids (PWUO) recruited from methadone and detoxification programs in NJ. The anonymous survey was based on a prior qualitative study of attitudes and behaviors surrounding opioid use. Multivariate analysis identified correlates of intentional fentanyl use in the full sample and among sub-populations of white and non-white PWUO. RESULTS In the full sample, intentional fentanyl use was associated with white race/ethnicity, younger age, polydrug use, and a preference for the drug effects of fentanyl, which more than tripled the probability of intentional use (AOR=3.02; 95% CI=1.86-4.89; p=.000). Among whites, a preference for the fentanyl drug effects was also the strongest predictor of intentional use (AOR=5.34; 95% CI=2.78-10.28; p=.000). Among non-whites, however, exposure, not preference, was the primary driver of use, with intentional use more than doubling (AOR=2.48; 95% CI=1.04-5.91; p<.05) among those living in high fentanyl dispersion counties. CONCLUSION The motivations underlying fentanyl use are multifactorial and vary across populations of PWUO, indicating a need for targeted interventions to counter the increasing spread and adverse consequences of fentanyl use. In order to counteract the increasing spread and adverse consequences of fentanyl use, these findings indicate a need for harm-reduction interventions, like drug testing or supervised injection sites, that address the differing motivations for fentanyl use among PWUO.
Multiple deployments are common among military personnel who served in Operation Enduring Freedom... more Multiple deployments are common among military personnel who served in Operation Enduring Freedom and Operation Iraqi Freedom and are associated with greater posttraumatic stress symptoms (PTSS). Homefront stressors (i.e., family, occupational problems) resulting from deployments may increase the risk of PTSS. Moreover, with multiple deployments, a new deployment may occur while still experiencing homefront stressors from previous tours. This prospective study assessed whether homefront stressors from a previous tour increased the risk of PTSS after a new deployment. It also examined the effects of homefront stressors at postdeployment.
... PsyD, ABPP, David A. Smelson, PsyD, Anna Kline, PhD, Bradley Sussner, PhD, Erik Faust, PhD, a... more ... PsyD, ABPP, David A. Smelson, PsyD, Anna Kline, PhD, Bradley Sussner, PhD, Erik Faust, PhD, and Seung Min Lee ... increasingly interested in examining the relationship between cognition and treatment outcome among substance abusing indi-viduals (Aharonovich et al ...
BackgroundMethadone maintenance therapy (MMT) is an efficacious form of medication assisted treat... more BackgroundMethadone maintenance therapy (MMT) is an efficacious form of medication assisted treatment for opioid use disorder (OUD), yet many individuals on MMT relapse. Chronic pain and deficits in positive affective response to natural rewards may result in dysphoria that fuels opioid craving and promotes relapse. As such, behavioral therapies that ameliorate chronic pain and enhance positive affect may serve as useful adjuncts to MMT. This analysis of ecological momentary assessment (EMA) data from a Stage 1 pilot clinical trial examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on opioid craving, pain, and positive affective state.MethodsParticipants with OUD and chronic pain (N=30) were randomized to 8 weeks of MORE or treatment as usual (TAU). Across 8 weeks of treatment, participants completed up to 112 random EMA measures of craving, pain, and affect, as well as event-contingent craving ratings. Multilevel models examined the effects of MORE on craving, pain, and affect, as well as the association between positive affect and craving.ResultsEMA showed significantly greater improvements in craving, pain unpleasantness, stress, and positive affect for participants in MORE than for participants in TAU. Participants in MORE reported having nearly 1.3 times greater self-control over craving than those in TAU. Further, positive affect was associated with reduced craving, an association that was significantly stronger among participants in MORE than TAU.ConclusionMORE may be a useful non-pharmacological adjunct among individuals with OUD and chronic pain in MMT.
Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suici... more Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suicide, using a go/no-go task.
Purpose of Review The purpose of this review is to provide a review of the current literature sur... more Purpose of Review The purpose of this review is to provide a review of the current literature surrounding opioid overdose risk factors, focusing on relatively new factors in the opioid crisis. Recent Findings Both a market supply driving force and a subpopulation of people who use opioids actively seeking out fentanyl are contributing to its recent proliferation in the opioid market. Harm reduction techniques such as fentanyl testing strips, naloxone education and distribution, drug sampling behaviors, and supervised injection facilities are all seeing expanded use with increasing amounts of research being published regarding their effectiveness. Availability and use of interventions such as medication for opioid use disorder and peer recovery coaching programs are also on the rise to prevent opioid overdose. Summary The opioid epidemic is an evolving crisis, necessitating continuing research to identify novel overdose risk factors and the development of new interventions targeting at-risk populations.
Aims: Benzodiazepines (BZs) are abused widely, yet it is not clear to what extent abuse-related e... more Aims: Benzodiazepines (BZs) are abused widely, yet it is not clear to what extent abuse-related effects can be dissociated from therapeutic effects such as anxiolysis. Recent data have suggested that ␣3 subunit-containing GABAA receptors (␣3GABAA receptors)
... Bradley D. Sussner United States Department of Veterans Affairs Anna Kline United States Depa... more ... Bradley D. Sussner United States Department of Veterans Affairs Anna Kline United States Department of Veterans Affairs and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School David ...
Once suicidal thoughts have emerged as a feature of depression they are likely to be reactivated ... more Once suicidal thoughts have emerged as a feature of depression they are likely to be reactivated as part of a suicidal mode of mind whenever sad mood reappears. This article reviews the methods and the usefulness of mindfulness-based cognitive therapy (MBCT) as a treatment for the prevention of the reactivation of the suicidal mode. MBCT integrates mindfulness meditation practices and cognitive therapy techniques. It teaches participants to develop moment-by-moment awareness, approaching ongoing experience with an attitude of nonjudgment and acceptance. Participants are increasingly able to see their thoughts as mental events rather than facts (metacognitive awareness). A case example illustrates how mindfulness skills develop with MBCT and how they relate to the cognitive processes that fuel suicidal crises. An ongoing controlled trial will provide further evidence, but pilot work suggests that MBCT is a promising intervention for those who have experienced suicidal ideation in the past.
Psychosocial differences between criminal-justice-referred and voluntary clients, using a sample ... more Psychosocial differences between criminal-justice-referred and voluntary clients, using a sample of 996 men and women in residential drug treatment in northern New Jersey, were explored. Results suggest differences in demographic characteristics between the two groups as well as differences in attitudes and behaviors likely to impact on treatment outcome. Demographically, criminal-justice clients are younger, more likely to be male, and less likely to be Black than other clients. They also report better health status and better social and psychological adjustment. reporting less homelessness, fewer health problems, lower levels of psychological distress, better family adjustment. and fewer medical, social, and drug problems requiring intervention. Implications for treatment are discussed.
Catastrophic appraisal has been implicated as a possible cause of psychiatric morbidity, psycholo... more Catastrophic appraisal has been implicated as a possible cause of psychiatric morbidity, psychological distress, and physical impairment in individuals with chronic pain. At issue in this study was whether catastrophizing was associated with psychiatric morbidity in a population sample of National Guard members. In addition, we sought to determine whether it could account for individual differences in psychological distress and impaired physical function in the presence of acute and chronic pain. We performed a secondary analysis of an existing survey database. The original survey was designed to assess combat readiness in a population sample of 2995 National Guard troops about to deploy overseas. The database included screening instruments for psychiatric illness as well as continuous measures of psychological distress, pain perception, pain catastrophizing, and perceived physical function. Among Guard members reporting a problem with pain, frequent catastrophizing was associated with higher rates of depression, posttraumatic stress, alcohol dependence, and somatization-like illness. Higher rates were also associated with chronic as opposed to acute pain (except for alcohol dependence). Pain-related catastrophizing accounted for substantial variance in measures of psychological distress and physical impairment regardless of pain duration. Although catastrophizing beliefs are common in clinical settings, this study suggests that the phenomenon may be prevalent in the population at large and likely to influence the outcome of acute as well as chronic pain.
A recent cross-sectional study of National Guard troops found that pain and pain catastrophizing ... more A recent cross-sectional study of National Guard troops found that pain and pain catastrophizing were prevalent and highly correlated with posttraumatic stress disorder (PTSD). At issue in the present study was whether pain and catastrophizing before military deployment could account for individual differences in PTSD symptoms after deployment. An anonymous survey was administered to a population sample of New Jersey National Guard troops before they were sent overseas and again when they returned home (1 year later). The survey included a validated PTSD screening questionnaire, numerical ratings of pain intensity, and a measure of pain catastrophizing. A cohort of 922 National Guard members completed the survey before and after deployment. An uncontrolled analysis indicated that pain and catastrophizing before deployment were significantly but modestly associated with PTSD symptoms after deployment (accounting for 4.5% and 1.3% of the variance, respectively). A hierarchical regression model that controlled for sex, preexisting PTSD symptoms, and recent combat found that pain but not pain catastrophizing explained variance in postdeployment PTSD. The size of the effect, however, was negligible (0.8%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01). Consistent with previous research, a cross-sectional analysis revealed that postdeployment pain and catastrophizing successfully accounted for unique variance in postdeployment PTSD. The failure of longitudinal predictors in the present study, therefore, cannot be attributed to insensitive screening instruments. These findings offer little or no support for the hypothesis that predeployment pain and catastrophizing can account for individual differences in PTSD after exposure to combat trauma.
Background: Chronic pain is highly prevalent among people in methadone maintenance treatment (MMT... more Background: Chronic pain is highly prevalent among people in methadone maintenance treatment (MMT) for opioid use disorder and is known to be an important contributor to treatment discontinuation and opioid relapse. Mindfulness-Oriented Recovery Enhancement (MORE) is one of the few interventions developed and tested as an integrated treatment to simultaneously address both pain and illicit opioid use; however, this study is the first to evaluate MORE as an adjunct to MMT. Methods: Randomized individuals in MMT (N = 30) received MORE plus methadone TAU (n = 15) or methadone TAU, only (n = 15). Participants in the MORE arm received their MMT, as usual, and attended eight, weekly, two-hour MORE groups at their MMT clinics. Participants in the TAU arm received their MMT, as usual, and group or individual counseling, as required by the clinic. TAU counseling consisted of relapse prevention, cognitive-behavioral therapy, and supportive treatment. TAU participants did not receive any mindfulness-based intervention. Participants completed assessments at baseline, post-treatment (i.e., 8-weeks post-baseline), and follow-up (i.e., 16-weeks post-baseline). Results: Participants in MORE evidenced significantly fewer baseline adjusted days of illicit drug use and significantly lower levels of craving through 16-week follow-up compared to TAU. Also, Participants in MORE reported significantly lower levels of pain, physical and emotional limitations, depression, and anxiety through 16-week follow-up compared to TAU. Conversely, participants in MORE reported significantly higher levels of well-being, vitality, and social functioning through 16-week follow-up compared to TAU. Conclusion: MORE could be an effective adjunct to MMT, and larger trials are warranted.
Abstract Background: To address the alarming rise in opioid overdose deaths, states have increase... more Abstract Background: To address the alarming rise in opioid overdose deaths, states have increased public access to the overdose reversal medication, naloxone. While some studies suggest that increased naloxone accessibility reduces opioid overdose deaths, others raise concerns about unintended consequences, such as increases in risky drug use and opioid re-use post-overdose to counter naloxone-induced withdrawal symptoms. Few studies have examined the impact of expanded naloxone access on the attitudes and behaviors of opioid users. Methods: In this qualitative study, we conducted in-depth, semi-structured interviews with 36 English-speaking opioid users 18+ years of age. Informants were recruited from an urban methadone clinic, a needle exchange program and a residential treatment program. The approximately hour-long interviews focused on users’ attitudes and behaviors surrounding naloxone, opioid use and overdose. Transcribed audio-recordings of interviews were analyzed using NVivo. Results: Informants were ambivalent about naloxone, widely acknowledging its life-saving benefits while reporting such negative effects as severe withdrawal symptoms and the promotion of riskier drug use. Naloxone-induced withdrawal, coupled with misperceptions about naloxone’s pharmacological effects, prompted overdose survivors to rapidly re-use opioids and refuse hospitalization following an overdose reversal. About half the sample believed naloxone led to greater risk-taking by others, such as fentanyl use or use in higher quantities, but did not endorse riskier drug use themselves. Conclusions: The results suggest the need for targeted education about the pharmacological effects of naloxone and better strategies for managing naloxone-induced withdrawal. Future research should focus on the extent to which naloxone is associated with greater opioid risk-taking.
BACKGROUND Attempts to reduce opioid overdoses have been complicated by the dramatic rise in fent... more BACKGROUND Attempts to reduce opioid overdoses have been complicated by the dramatic rise in fentanyl use. While market forces contributing to fentanyl proliferation in the illicit drug supply have increased inadvertent exposure to the drug, rising fentanyl use may also be driven by growing consumer demand. Interventions to reduce the spread of fentanyl must be based on an understanding of the motivations underlying its use. METHODS Data for this cross-sectional study were derived from a computerized self-administered survey completed by a convenience sample of 432 people who use illicit opioids (PWUO) recruited from methadone and detoxification programs in NJ. The anonymous survey was based on a prior qualitative study of attitudes and behaviors surrounding opioid use. Multivariate analysis identified correlates of intentional fentanyl use in the full sample and among sub-populations of white and non-white PWUO. RESULTS In the full sample, intentional fentanyl use was associated with white race/ethnicity, younger age, polydrug use, and a preference for the drug effects of fentanyl, which more than tripled the probability of intentional use (AOR=3.02; 95% CI=1.86-4.89; p=.000). Among whites, a preference for the fentanyl drug effects was also the strongest predictor of intentional use (AOR=5.34; 95% CI=2.78-10.28; p=.000). Among non-whites, however, exposure, not preference, was the primary driver of use, with intentional use more than doubling (AOR=2.48; 95% CI=1.04-5.91; p<.05) among those living in high fentanyl dispersion counties. CONCLUSION The motivations underlying fentanyl use are multifactorial and vary across populations of PWUO, indicating a need for targeted interventions to counter the increasing spread and adverse consequences of fentanyl use. In order to counteract the increasing spread and adverse consequences of fentanyl use, these findings indicate a need for harm-reduction interventions, like drug testing or supervised injection sites, that address the differing motivations for fentanyl use among PWUO.
Multiple deployments are common among military personnel who served in Operation Enduring Freedom... more Multiple deployments are common among military personnel who served in Operation Enduring Freedom and Operation Iraqi Freedom and are associated with greater posttraumatic stress symptoms (PTSS). Homefront stressors (i.e., family, occupational problems) resulting from deployments may increase the risk of PTSS. Moreover, with multiple deployments, a new deployment may occur while still experiencing homefront stressors from previous tours. This prospective study assessed whether homefront stressors from a previous tour increased the risk of PTSS after a new deployment. It also examined the effects of homefront stressors at postdeployment.
... PsyD, ABPP, David A. Smelson, PsyD, Anna Kline, PhD, Bradley Sussner, PhD, Erik Faust, PhD, a... more ... PsyD, ABPP, David A. Smelson, PsyD, Anna Kline, PhD, Bradley Sussner, PhD, Erik Faust, PhD, and Seung Min Lee ... increasingly interested in examining the relationship between cognition and treatment outcome among substance abusing indi-viduals (Aharonovich et al ...
BackgroundMethadone maintenance therapy (MMT) is an efficacious form of medication assisted treat... more BackgroundMethadone maintenance therapy (MMT) is an efficacious form of medication assisted treatment for opioid use disorder (OUD), yet many individuals on MMT relapse. Chronic pain and deficits in positive affective response to natural rewards may result in dysphoria that fuels opioid craving and promotes relapse. As such, behavioral therapies that ameliorate chronic pain and enhance positive affect may serve as useful adjuncts to MMT. This analysis of ecological momentary assessment (EMA) data from a Stage 1 pilot clinical trial examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on opioid craving, pain, and positive affective state.MethodsParticipants with OUD and chronic pain (N=30) were randomized to 8 weeks of MORE or treatment as usual (TAU). Across 8 weeks of treatment, participants completed up to 112 random EMA measures of craving, pain, and affect, as well as event-contingent craving ratings. Multilevel models examined the effects of MORE on craving, pain, and affect, as well as the association between positive affect and craving.ResultsEMA showed significantly greater improvements in craving, pain unpleasantness, stress, and positive affect for participants in MORE than for participants in TAU. Participants in MORE reported having nearly 1.3 times greater self-control over craving than those in TAU. Further, positive affect was associated with reduced craving, an association that was significantly stronger among participants in MORE than TAU.ConclusionMORE may be a useful non-pharmacological adjunct among individuals with OUD and chronic pain in MMT.
Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suici... more Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suicide, using a go/no-go task.
Purpose of Review The purpose of this review is to provide a review of the current literature sur... more Purpose of Review The purpose of this review is to provide a review of the current literature surrounding opioid overdose risk factors, focusing on relatively new factors in the opioid crisis. Recent Findings Both a market supply driving force and a subpopulation of people who use opioids actively seeking out fentanyl are contributing to its recent proliferation in the opioid market. Harm reduction techniques such as fentanyl testing strips, naloxone education and distribution, drug sampling behaviors, and supervised injection facilities are all seeing expanded use with increasing amounts of research being published regarding their effectiveness. Availability and use of interventions such as medication for opioid use disorder and peer recovery coaching programs are also on the rise to prevent opioid overdose. Summary The opioid epidemic is an evolving crisis, necessitating continuing research to identify novel overdose risk factors and the development of new interventions targeting at-risk populations.
Aims: Benzodiazepines (BZs) are abused widely, yet it is not clear to what extent abuse-related e... more Aims: Benzodiazepines (BZs) are abused widely, yet it is not clear to what extent abuse-related effects can be dissociated from therapeutic effects such as anxiolysis. Recent data have suggested that ␣3 subunit-containing GABAA receptors (␣3GABAA receptors)
... Bradley D. Sussner United States Department of Veterans Affairs Anna Kline United States Depa... more ... Bradley D. Sussner United States Department of Veterans Affairs Anna Kline United States Department of Veterans Affairs and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School David ...
Once suicidal thoughts have emerged as a feature of depression they are likely to be reactivated ... more Once suicidal thoughts have emerged as a feature of depression they are likely to be reactivated as part of a suicidal mode of mind whenever sad mood reappears. This article reviews the methods and the usefulness of mindfulness-based cognitive therapy (MBCT) as a treatment for the prevention of the reactivation of the suicidal mode. MBCT integrates mindfulness meditation practices and cognitive therapy techniques. It teaches participants to develop moment-by-moment awareness, approaching ongoing experience with an attitude of nonjudgment and acceptance. Participants are increasingly able to see their thoughts as mental events rather than facts (metacognitive awareness). A case example illustrates how mindfulness skills develop with MBCT and how they relate to the cognitive processes that fuel suicidal crises. An ongoing controlled trial will provide further evidence, but pilot work suggests that MBCT is a promising intervention for those who have experienced suicidal ideation in the past.
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